Marina Obradov - Academia.edu (original) (raw)

Papers by Marina Obradov

Research paper thumbnail of EULAR Points to Consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs)

Annals of the Rheumatic Diseases, 2021

Objectives To develop evidence-based Points to Consider (PtC) for the use of imaging modalities t... more Objectives To develop evidence-based Points to Consider (PtC) for the use of imaging modalities to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). Methods European Alliance of Associations for Rheumatology (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound (US), fluoroscopy, MRI, CT and fusion imaging to guide interventional procedures. Based on evidence and expert opinion, the task force (25 participants consisting of physicians, healthcare professionals and patients from 11 countries) developed PtC, with consensus obtained through voting. The final level of agreement was provided anonymously. Results A total of three overarching principles and six specific PtC were formulated. The task force recommends preference of imaging over palpation to guide targeted interventional procedures at peripheral joints, periartic...

Research paper thumbnail of Kinematic Magnetic Resonance Imaging Assessment of the Degenerative Cervical Spine: Changes after Anterior Decompression and Cage Fusion

Global Spine Journal, 2016

Study Design A prospective cohort study. Objective Decompression and fusion of cervical vertebrae... more Study Design A prospective cohort study. Objective Decompression and fusion of cervical vertebrae is a combined procedure that has a high success rate in relieving radicular symptoms and stabilizing or improving cervical myelopathy. However, fusion may lead to increased motion of the adjacent vertebrae and cervical deformity. Both have been postulated to lead to adjacent segment pathology (ASP). Kinematic magnetic resonance imaging (MRI) has been increasingly used to evaluate range of motion (ROM) of the cervical spine and ASP. Our objective was to measure ASP, cervical curvature, and ROM of individual segments of the cervical spine using kinematic MRI before and 24 months after monosegmental cage fusion. Methods Eighteen patients who had single-level interbody fusion were included. ROM (using kinematic MRI) and degeneration, spinal stenosis, and cervical curvature were measured preoperatively and 24 months postoperatively. Results Using kinematic MRI, segmental motion of the cervic...

Research paper thumbnail of US findings for chronic lateral epicondylitis

Journal of the Belgian Society of Radiology, 2012

Research paper thumbnail of Pre-existent vertebral rotation in the human spine is influenced by body position

Studies in Health Technology and Informatics, 2010

Human bipedalism appears to be a prerequisite for the development of idiopathic scoliosis. The ob... more Human bipedalism appears to be a prerequisite for the development of idiopathic scoliosis. The objective of this study was to examine the effect of different positions of the human spine on vertebral rotation in vivo. Thirty asymptomatic volunteers underwent MRI scanning of the spine in three different body positions; upright, quadrupedal-like and supine. Vertebral rotation in the local transverse plane was measured and compared at different spinal levels between the three body positions. It was shown that in all three positions the mid and lower thoracic vertebrae were predominantly rotated to the right. However, rotation was significantly less in certain areas of the spine in the quadrupedal-like position than in both the standing upright and supine positions. We hypothesize that the erect position of the human spine, but also the supine position, increases dorsally directed shear loads that may increase the tendency of certain spinal segments to rotate.

Research paper thumbnail of Shoulder Procedures: Intra-Articular

The intra-articular X-ray and US-guided acromio-clavicular and gleno-humeral injection procedures... more The intra-articular X-ray and US-guided acromio-clavicular and gleno-humeral injection procedures are reviewed. The technical principles of the injections used for diagnostic or therapeutic grounds are reviewed. Indications, anatomy, proper techniques and approach, choice of equipment, quantity of pharmaceuticals and appropriate aftercare as well as possible procedure-related symptoms and their treatment are discussed.

Research paper thumbnail of Image-guided Intra- and Extra-articular Musculoskeletal Interventions

Research paper thumbnail of Elbow Procedures, Intra-Articular

The intra-articular X-ray and US-guided elbow injection procedures are reviewed. The technical pr... more The intra-articular X-ray and US-guided elbow injection procedures are reviewed. The technical principles of the elbow injection used for diagnostic or therapeutic reason are discussed. Indications, anatomy, proper techniques and approach, choice of equipment, quantity of pharmaceuticals, and appropriate aftercare as well as possible procedure-related symptoms and their treatment are discussed.

Research paper thumbnail of Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part I, shoulder

Research paper thumbnail of Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

Seminars in Musculoskeletal Radiology

Pain around the hip and pelvis is a very common condition. Pain may be generated within the joint... more Pain around the hip and pelvis is a very common condition. Pain may be generated within the joint space (i.e. the hip joint itself, the sacroiliac joints or the pubic symphysis) or from surrounding myotendinous, bursal, or nerve structures. Over the years, percutaneous musculoskeletal procedures have become increasingly popular to diagnose and treat painful conditions around the hip and the pelvis. Most intra- and extra-articular procedures are performed under ultrasound guidance. This article reviews the most common diagnostic and therapeutic procedures that can be performed around the hip and the pelvis under ultrasound guidance.

Research paper thumbnail of Kinematic Magnetic Resonance Imaging Assessment of the Degenerative Cervical Spine: Changes after Anterior Decompression and Cage Fusion

Global Spine Journal, 2016

Research paper thumbnail of Radiologic Imaging of Elbow and Forearm Injuries

Nuclear Medicine and Radiologic Imaging in Sports Injuries, 2015

ABSTRACT Abstract The elbow joint has a complex “trochoginglymoid “architecture which allows for ... more ABSTRACT Abstract The elbow joint has a complex “trochoginglymoid “architecture which allows for the wide range of motion, including hinged (elbow flexion and extension) and rotational (forearm supination and pronation) motion. Stability is dependent on the congruity of this articulation with major support of the medial and lateral ligament complex but with only a minor contribution of the muscles. Acute varus, valgus, anterior, and posterolateral overload may result in a variety of fractures and lead to recurrent instability and overuse injury. Although lower limb injuries are the most common and comprise 74 % of all sports injuries (Alonso et al. 2012), upper limb injuries are an important cause of reduced performance and loss of playing time for athletes. Upper limb injuries are most common in throwing sports but frequently occur in weight-lifting sports as well. Imaging of acute injuries in most cases involves conventional radiographs to visualise osseous anatomy and pathology but offers only limited soft tissue evaluation. US provides high-resolution images of the muscle, tendons, and ligaments, including dynamic assessment of the joint movement and (sub)luxation of the tendons and nerves. Hypervascularisation and angiogenesis are easily assessed with Doppler ultrasound. The ultrasound examination is typically focused on the area of tenderness and discomfort. MRI and MR arthrography are the best imaging techniques in complex pathology with involvement of bone, joint, and soft tissues. The 2D and 3D multiplanar reconstruction capacity of CT depicts the complex osseous anatomy and pathology in fracture dislocation and fracture healing and in soft tissue calcification and ossification. Good knowledge of the (functional) anatomy and its variants is mandatory.

Research paper thumbnail of Ultra sonographic findings for chronic lateral epicondylitis

JBR-BTR: organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)

To assess which individual gray-scale and color Doppler US findings and their combination are str... more To assess which individual gray-scale and color Doppler US findings and their combination are strongly associated with lateral epicondylitis. Also to determine whether chronic lateral epicondylitis is possible without any positive US findings. 49 patients (6 bilateral) underwent gray-scale ultrasonic imaging between 2005 to 2007. All had a history of lateral epicondylitis and had concordant pain during US probe compression in the common extensor region. Mean patient age was 47 (sd 7.7) years; M/F ratio 21/28; L/R ratio 17/32. Five symptom free volunteers (all bilateral) with a mean age of 36 (sd 8.7) years; M/F = 4/6; L/R = 5/5. Neovascularity determined by color Doppler and four gray-scale US findings - a convex external contour, an erosive lateral epicondular cortex, internal calcifications, or a tear - have a specificity and PPV of 100% with conclusive likelihood ratios. However, only the sensitivity for neovascularity is above 50%. A combination of gray-scale and color Doppler s...

Research paper thumbnail of Ultrasonografic Findings for Lateral Epicondylitis

JBR-BTR (Journal Belge de Radiologie - Belgisch Tijdschrift voor Radiologi)

Research paper thumbnail of Good functional outcome and adjacent segment disc quality 10 years after single-level anterior lumbar interbody fusion with posterior fixation

Global spine journal, 2012

We reviewed the records of a prospective consecutive cohort to evaluate the clinical performance ... more We reviewed the records of a prospective consecutive cohort to evaluate the clinical performance of anterior lumbar interbody fusion with a titanium box cage and posterior fixation, with emphasis on long-term functional outcome. Thirty-two patients with chronic low back pain underwent anterior lumbar interbody fusion and posterior fixation. Radiological and functional results (visual analogue scale [VAS] and Oswestry score) were evaluated. Adjacent segment degeneration (ASD) was evaluated radiologically and by magnetic resonance imaging (MRI). Twenty-five patients (78%) were available for follow-up. Functional scores showed significant improvement in pain and function up to the 2-year follow-up observation. At 4 years, there was some deterioration of the clinical results. At 10-year follow-up, results remained stable compared with 4-year results. MRI showed ASD in 3/25 (12%) above and 2/10 (20%) below index level (compared with absent preoperatively). ASD could not be related to cli...

Research paper thumbnail of Andersson lesion in ankylosing spondylitis

The Spine Journal, 2014

Andersson lesions are destructive foci that appear at the discovertebral junction in ankylosing s... more Andersson lesions are destructive foci that appear at the discovertebral junction in ankylosing spondylitis. We report three cases of ankylosing spondylitis with such lesions. These lesions simulate an infection and in our country, mimic spinal tuberculosis.

Research paper thumbnail of Good Outcome and Restoration of Lordosis After Anterior Lumbar Interbody Fusion With Additional Posterior Fixation

Spine, 2004

Fifty-two patients with degenerative disc disease underwent single- or double-level anterior lumb... more Fifty-two patients with degenerative disc disease underwent single- or double-level anterior lumbar interbody fusion with SynCage and additional posterior fixation as treatment for degenerative disc disease and were prospectively followed for 4 years. To test the clinical performance of anterior lumbar interbody fusion with SynCage, with emphasis on the safety and efficacy of the surgical procedure and the ability to restore anatomy and fuse the motion segment. Anterior lumbar interbody fusion using femoral allograft and/or autologous bone has a high complication rate. With cage technology, some of these complications can be avoided. The design characteristics of the SynCage offer advantages in restoring and maintaining intervertebral height and restoration of lumbar lordosis. Thirty-three patients underwent single-level and 19 patients double-level anterior lumbar interbody fusion with SynCage and additional posterior fixation (translaminar screws, n = 32 or pedicle screws, n = 10). Radiologic and functional results (VAS and Oswestry score) were evaluated. Intervertebral height was corrected from an average of 8.7 to 17.6 mm. Lordosis of the fused segment was significantly increased (average 10.6 degrees for the fused segment and 8 degrees for lumbosacral lordosis). After 2 years, there was radiologic evidence for fusion in 70 of 71 (98.6%) levels. Functional scores showed a significant improvement in pain and function up to the 2-year follow-up observation. At the 4-year follow-up observation, there was some loss of the initial improvement in VAS and Oswestry scores. Despite this loss, they remained significantly better than the preoperative scores. Anterior lumbar interbody fusion with SynCage and additional posterior fixation is a safe and effective procedure. Intervertebral height is corrected, and lumbosacral lordosis is restored. An initial improvement in VAS and Oswestry scores is partly lost at the 4-year follow-up observation, but 4-year results are still significantly better than the preoperative scores.

Research paper thumbnail of Regional migratory osteoporosis in a patient with ankylosing spondylitis

Scandinavian Journal of Rheumatology, 2009

We report the first case of regional migratory osteoporosis (RMO) in a patient with ankylosing sp... more We report the first case of regional migratory osteoporosis (RMO) in a patient with ankylosing spondylitis (AS). This middle-aged man suffered from an acute onset of knee pain that increased on weight bearing, followed by ankle pain. The diagnosis of RMO was confirmed using magnetic resonance imaging (MRI), after exclusion of other causes of knee pain. MRI revealed a large area of bone marrow oedema without a zone of demarcation or subchondral fracture with a demonstration of shifting marrow oedema on the follow-up MRI scan from the medial femur condyl to the tibia plateau lateral and then to the distal tibia epiphysis. Treatment with the bisphosphonate ibandronate, however, was unsuccessful. RMO is characterized clinically by migrating arthralgia of the weight-bearing joints of the lower limbs, mainly in middle-aged males. Although the aetiology is unknown, the pathophysiology of RMO seems to be closely related to transient osteoporosis of the hip (TOH), which has been considered a reversible stage of avascular necrosis of the hip (AVN). There is no causal treatment for RMO. Avoidance of weight bearing and use of analgesics are effective in reducing symptoms. The combination of RMO and AS yielded diagnostic difficulties, as the clinical picture and the marrow oedema seen on MRI could be attributed to several AS-related causes such as enthesitis, early stadium of arthritis, osteonecrosis, or sterile osteomyelitis.

Research paper thumbnail of CT Density Measurement of Bone Graft Within an Intervertebral Lumbar Cage

Journal of Spinal Disorders & Techniques, 2004

ABSTRACT Radiographic assessment of lumbar interbody fusion is difficult, especially in the prese... more ABSTRACT Radiographic assessment of lumbar interbody fusion is difficult, especially in the presence of cages and metal artifacts. The purpose of this study is to assess whether impacted bone chips in intervertebral lumbar cages show a tendency toward increased attenuation on postoperative computed tomography (CT) scans as a sign of ongoing revascularization and increased bone mineral content inside the cage. Twenty-one patients with single- or double-level lumbar fusion underwent CT scanning 1-44 months postoperatively. CT attenuation of bone inside the cage was measured with Hounsfield units. Intra- and interobserver variability were evaluated. Regression analysis showed an increase of 7.5 HU/month postoperatively for an initial value of 615 HU. Intra- and interobserver variability showed an interclass coefficient of 0.97. CT attenuation of bone graft inside an intervertebral cage increases in the postoperative period. Hounsfield unit measurement can be performed with a high degree of accuracy and reproducibility and may in the future provide a useful tool in studying cage contents in individual patients.

Research paper thumbnail of Sonography after total hip replacement: Reproducibility and normal values in 47 clinically uncomplicated cases

Acta Orthopaedica, 2007

Background and purpose Interpretation of sonographic data is difficult when hematoma after total ... more Background and purpose Interpretation of sonographic data is difficult when hematoma after total hip replacement is suspected, as there are no normative data. We describe the normal sonographic image, focusing on the amount and location of postoperative fluid collections after a clinically uncomplicated, primary total hip replacement by the posterior approach. Inter-and intraobserver reproducibility is also considered.

Research paper thumbnail of Pre-existent vertebral rotation in the human spine is influenced by body position

European Spine Journal, 2010

Both the humans as well as the quadrupedal spine have been shown to exhibit a pattern of pre-exis... more Both the humans as well as the quadrupedal spine have been shown to exhibit a pattern of pre-existent rotation that is similar in direction to what is found in the most common types of idiopathic scoliosis. It has been postulated that human bipedalism introduces forces to the spine that increase a tendency of the vertebrae to rotate. The objective of this study was to examine the effect of body position on vertebral rotation in vivo. Thirty asymptomatic volunteers underwent magnetic resonance imaging scanning of the spine (T2-L5) in three different body positions; upright, quadrupedal-like (on hands-andknees) and supine. Vertebral rotation in the local transverse plane was measured according to a pre-established method and compared at different spinal levels between the three body positions. It was shown that in all three positions the mid-and lower thoracic vertebrae were predominantly rotated to the right. However, vertebral rotation was significantly less in the quadrupedal position than in both the standing upright and supine positions.

Research paper thumbnail of EULAR Points to Consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs)

Annals of the Rheumatic Diseases, 2021

Objectives To develop evidence-based Points to Consider (PtC) for the use of imaging modalities t... more Objectives To develop evidence-based Points to Consider (PtC) for the use of imaging modalities to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). Methods European Alliance of Associations for Rheumatology (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound (US), fluoroscopy, MRI, CT and fusion imaging to guide interventional procedures. Based on evidence and expert opinion, the task force (25 participants consisting of physicians, healthcare professionals and patients from 11 countries) developed PtC, with consensus obtained through voting. The final level of agreement was provided anonymously. Results A total of three overarching principles and six specific PtC were formulated. The task force recommends preference of imaging over palpation to guide targeted interventional procedures at peripheral joints, periartic...

Research paper thumbnail of Kinematic Magnetic Resonance Imaging Assessment of the Degenerative Cervical Spine: Changes after Anterior Decompression and Cage Fusion

Global Spine Journal, 2016

Study Design A prospective cohort study. Objective Decompression and fusion of cervical vertebrae... more Study Design A prospective cohort study. Objective Decompression and fusion of cervical vertebrae is a combined procedure that has a high success rate in relieving radicular symptoms and stabilizing or improving cervical myelopathy. However, fusion may lead to increased motion of the adjacent vertebrae and cervical deformity. Both have been postulated to lead to adjacent segment pathology (ASP). Kinematic magnetic resonance imaging (MRI) has been increasingly used to evaluate range of motion (ROM) of the cervical spine and ASP. Our objective was to measure ASP, cervical curvature, and ROM of individual segments of the cervical spine using kinematic MRI before and 24 months after monosegmental cage fusion. Methods Eighteen patients who had single-level interbody fusion were included. ROM (using kinematic MRI) and degeneration, spinal stenosis, and cervical curvature were measured preoperatively and 24 months postoperatively. Results Using kinematic MRI, segmental motion of the cervic...

Research paper thumbnail of US findings for chronic lateral epicondylitis

Journal of the Belgian Society of Radiology, 2012

Research paper thumbnail of Pre-existent vertebral rotation in the human spine is influenced by body position

Studies in Health Technology and Informatics, 2010

Human bipedalism appears to be a prerequisite for the development of idiopathic scoliosis. The ob... more Human bipedalism appears to be a prerequisite for the development of idiopathic scoliosis. The objective of this study was to examine the effect of different positions of the human spine on vertebral rotation in vivo. Thirty asymptomatic volunteers underwent MRI scanning of the spine in three different body positions; upright, quadrupedal-like and supine. Vertebral rotation in the local transverse plane was measured and compared at different spinal levels between the three body positions. It was shown that in all three positions the mid and lower thoracic vertebrae were predominantly rotated to the right. However, rotation was significantly less in certain areas of the spine in the quadrupedal-like position than in both the standing upright and supine positions. We hypothesize that the erect position of the human spine, but also the supine position, increases dorsally directed shear loads that may increase the tendency of certain spinal segments to rotate.

Research paper thumbnail of Shoulder Procedures: Intra-Articular

The intra-articular X-ray and US-guided acromio-clavicular and gleno-humeral injection procedures... more The intra-articular X-ray and US-guided acromio-clavicular and gleno-humeral injection procedures are reviewed. The technical principles of the injections used for diagnostic or therapeutic grounds are reviewed. Indications, anatomy, proper techniques and approach, choice of equipment, quantity of pharmaceuticals and appropriate aftercare as well as possible procedure-related symptoms and their treatment are discussed.

Research paper thumbnail of Image-guided Intra- and Extra-articular Musculoskeletal Interventions

Research paper thumbnail of Elbow Procedures, Intra-Articular

The intra-articular X-ray and US-guided elbow injection procedures are reviewed. The technical pr... more The intra-articular X-ray and US-guided elbow injection procedures are reviewed. The technical principles of the elbow injection used for diagnostic or therapeutic reason are discussed. Indications, anatomy, proper techniques and approach, choice of equipment, quantity of pharmaceuticals, and appropriate aftercare as well as possible procedure-related symptoms and their treatment are discussed.

Research paper thumbnail of Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part I, shoulder

Research paper thumbnail of Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

Seminars in Musculoskeletal Radiology

Pain around the hip and pelvis is a very common condition. Pain may be generated within the joint... more Pain around the hip and pelvis is a very common condition. Pain may be generated within the joint space (i.e. the hip joint itself, the sacroiliac joints or the pubic symphysis) or from surrounding myotendinous, bursal, or nerve structures. Over the years, percutaneous musculoskeletal procedures have become increasingly popular to diagnose and treat painful conditions around the hip and the pelvis. Most intra- and extra-articular procedures are performed under ultrasound guidance. This article reviews the most common diagnostic and therapeutic procedures that can be performed around the hip and the pelvis under ultrasound guidance.

Research paper thumbnail of Kinematic Magnetic Resonance Imaging Assessment of the Degenerative Cervical Spine: Changes after Anterior Decompression and Cage Fusion

Global Spine Journal, 2016

Research paper thumbnail of Radiologic Imaging of Elbow and Forearm Injuries

Nuclear Medicine and Radiologic Imaging in Sports Injuries, 2015

ABSTRACT Abstract The elbow joint has a complex “trochoginglymoid “architecture which allows for ... more ABSTRACT Abstract The elbow joint has a complex “trochoginglymoid “architecture which allows for the wide range of motion, including hinged (elbow flexion and extension) and rotational (forearm supination and pronation) motion. Stability is dependent on the congruity of this articulation with major support of the medial and lateral ligament complex but with only a minor contribution of the muscles. Acute varus, valgus, anterior, and posterolateral overload may result in a variety of fractures and lead to recurrent instability and overuse injury. Although lower limb injuries are the most common and comprise 74 % of all sports injuries (Alonso et al. 2012), upper limb injuries are an important cause of reduced performance and loss of playing time for athletes. Upper limb injuries are most common in throwing sports but frequently occur in weight-lifting sports as well. Imaging of acute injuries in most cases involves conventional radiographs to visualise osseous anatomy and pathology but offers only limited soft tissue evaluation. US provides high-resolution images of the muscle, tendons, and ligaments, including dynamic assessment of the joint movement and (sub)luxation of the tendons and nerves. Hypervascularisation and angiogenesis are easily assessed with Doppler ultrasound. The ultrasound examination is typically focused on the area of tenderness and discomfort. MRI and MR arthrography are the best imaging techniques in complex pathology with involvement of bone, joint, and soft tissues. The 2D and 3D multiplanar reconstruction capacity of CT depicts the complex osseous anatomy and pathology in fracture dislocation and fracture healing and in soft tissue calcification and ossification. Good knowledge of the (functional) anatomy and its variants is mandatory.

Research paper thumbnail of Ultra sonographic findings for chronic lateral epicondylitis

JBR-BTR: organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)

To assess which individual gray-scale and color Doppler US findings and their combination are str... more To assess which individual gray-scale and color Doppler US findings and their combination are strongly associated with lateral epicondylitis. Also to determine whether chronic lateral epicondylitis is possible without any positive US findings. 49 patients (6 bilateral) underwent gray-scale ultrasonic imaging between 2005 to 2007. All had a history of lateral epicondylitis and had concordant pain during US probe compression in the common extensor region. Mean patient age was 47 (sd 7.7) years; M/F ratio 21/28; L/R ratio 17/32. Five symptom free volunteers (all bilateral) with a mean age of 36 (sd 8.7) years; M/F = 4/6; L/R = 5/5. Neovascularity determined by color Doppler and four gray-scale US findings - a convex external contour, an erosive lateral epicondular cortex, internal calcifications, or a tear - have a specificity and PPV of 100% with conclusive likelihood ratios. However, only the sensitivity for neovascularity is above 50%. A combination of gray-scale and color Doppler s...

Research paper thumbnail of Ultrasonografic Findings for Lateral Epicondylitis

JBR-BTR (Journal Belge de Radiologie - Belgisch Tijdschrift voor Radiologi)

Research paper thumbnail of Good functional outcome and adjacent segment disc quality 10 years after single-level anterior lumbar interbody fusion with posterior fixation

Global spine journal, 2012

We reviewed the records of a prospective consecutive cohort to evaluate the clinical performance ... more We reviewed the records of a prospective consecutive cohort to evaluate the clinical performance of anterior lumbar interbody fusion with a titanium box cage and posterior fixation, with emphasis on long-term functional outcome. Thirty-two patients with chronic low back pain underwent anterior lumbar interbody fusion and posterior fixation. Radiological and functional results (visual analogue scale [VAS] and Oswestry score) were evaluated. Adjacent segment degeneration (ASD) was evaluated radiologically and by magnetic resonance imaging (MRI). Twenty-five patients (78%) were available for follow-up. Functional scores showed significant improvement in pain and function up to the 2-year follow-up observation. At 4 years, there was some deterioration of the clinical results. At 10-year follow-up, results remained stable compared with 4-year results. MRI showed ASD in 3/25 (12%) above and 2/10 (20%) below index level (compared with absent preoperatively). ASD could not be related to cli...

Research paper thumbnail of Andersson lesion in ankylosing spondylitis

The Spine Journal, 2014

Andersson lesions are destructive foci that appear at the discovertebral junction in ankylosing s... more Andersson lesions are destructive foci that appear at the discovertebral junction in ankylosing spondylitis. We report three cases of ankylosing spondylitis with such lesions. These lesions simulate an infection and in our country, mimic spinal tuberculosis.

Research paper thumbnail of Good Outcome and Restoration of Lordosis After Anterior Lumbar Interbody Fusion With Additional Posterior Fixation

Spine, 2004

Fifty-two patients with degenerative disc disease underwent single- or double-level anterior lumb... more Fifty-two patients with degenerative disc disease underwent single- or double-level anterior lumbar interbody fusion with SynCage and additional posterior fixation as treatment for degenerative disc disease and were prospectively followed for 4 years. To test the clinical performance of anterior lumbar interbody fusion with SynCage, with emphasis on the safety and efficacy of the surgical procedure and the ability to restore anatomy and fuse the motion segment. Anterior lumbar interbody fusion using femoral allograft and/or autologous bone has a high complication rate. With cage technology, some of these complications can be avoided. The design characteristics of the SynCage offer advantages in restoring and maintaining intervertebral height and restoration of lumbar lordosis. Thirty-three patients underwent single-level and 19 patients double-level anterior lumbar interbody fusion with SynCage and additional posterior fixation (translaminar screws, n = 32 or pedicle screws, n = 10). Radiologic and functional results (VAS and Oswestry score) were evaluated. Intervertebral height was corrected from an average of 8.7 to 17.6 mm. Lordosis of the fused segment was significantly increased (average 10.6 degrees for the fused segment and 8 degrees for lumbosacral lordosis). After 2 years, there was radiologic evidence for fusion in 70 of 71 (98.6%) levels. Functional scores showed a significant improvement in pain and function up to the 2-year follow-up observation. At the 4-year follow-up observation, there was some loss of the initial improvement in VAS and Oswestry scores. Despite this loss, they remained significantly better than the preoperative scores. Anterior lumbar interbody fusion with SynCage and additional posterior fixation is a safe and effective procedure. Intervertebral height is corrected, and lumbosacral lordosis is restored. An initial improvement in VAS and Oswestry scores is partly lost at the 4-year follow-up observation, but 4-year results are still significantly better than the preoperative scores.

Research paper thumbnail of Regional migratory osteoporosis in a patient with ankylosing spondylitis

Scandinavian Journal of Rheumatology, 2009

We report the first case of regional migratory osteoporosis (RMO) in a patient with ankylosing sp... more We report the first case of regional migratory osteoporosis (RMO) in a patient with ankylosing spondylitis (AS). This middle-aged man suffered from an acute onset of knee pain that increased on weight bearing, followed by ankle pain. The diagnosis of RMO was confirmed using magnetic resonance imaging (MRI), after exclusion of other causes of knee pain. MRI revealed a large area of bone marrow oedema without a zone of demarcation or subchondral fracture with a demonstration of shifting marrow oedema on the follow-up MRI scan from the medial femur condyl to the tibia plateau lateral and then to the distal tibia epiphysis. Treatment with the bisphosphonate ibandronate, however, was unsuccessful. RMO is characterized clinically by migrating arthralgia of the weight-bearing joints of the lower limbs, mainly in middle-aged males. Although the aetiology is unknown, the pathophysiology of RMO seems to be closely related to transient osteoporosis of the hip (TOH), which has been considered a reversible stage of avascular necrosis of the hip (AVN). There is no causal treatment for RMO. Avoidance of weight bearing and use of analgesics are effective in reducing symptoms. The combination of RMO and AS yielded diagnostic difficulties, as the clinical picture and the marrow oedema seen on MRI could be attributed to several AS-related causes such as enthesitis, early stadium of arthritis, osteonecrosis, or sterile osteomyelitis.

Research paper thumbnail of CT Density Measurement of Bone Graft Within an Intervertebral Lumbar Cage

Journal of Spinal Disorders & Techniques, 2004

ABSTRACT Radiographic assessment of lumbar interbody fusion is difficult, especially in the prese... more ABSTRACT Radiographic assessment of lumbar interbody fusion is difficult, especially in the presence of cages and metal artifacts. The purpose of this study is to assess whether impacted bone chips in intervertebral lumbar cages show a tendency toward increased attenuation on postoperative computed tomography (CT) scans as a sign of ongoing revascularization and increased bone mineral content inside the cage. Twenty-one patients with single- or double-level lumbar fusion underwent CT scanning 1-44 months postoperatively. CT attenuation of bone inside the cage was measured with Hounsfield units. Intra- and interobserver variability were evaluated. Regression analysis showed an increase of 7.5 HU/month postoperatively for an initial value of 615 HU. Intra- and interobserver variability showed an interclass coefficient of 0.97. CT attenuation of bone graft inside an intervertebral cage increases in the postoperative period. Hounsfield unit measurement can be performed with a high degree of accuracy and reproducibility and may in the future provide a useful tool in studying cage contents in individual patients.

Research paper thumbnail of Sonography after total hip replacement: Reproducibility and normal values in 47 clinically uncomplicated cases

Acta Orthopaedica, 2007

Background and purpose Interpretation of sonographic data is difficult when hematoma after total ... more Background and purpose Interpretation of sonographic data is difficult when hematoma after total hip replacement is suspected, as there are no normative data. We describe the normal sonographic image, focusing on the amount and location of postoperative fluid collections after a clinically uncomplicated, primary total hip replacement by the posterior approach. Inter-and intraobserver reproducibility is also considered.

Research paper thumbnail of Pre-existent vertebral rotation in the human spine is influenced by body position

European Spine Journal, 2010

Both the humans as well as the quadrupedal spine have been shown to exhibit a pattern of pre-exis... more Both the humans as well as the quadrupedal spine have been shown to exhibit a pattern of pre-existent rotation that is similar in direction to what is found in the most common types of idiopathic scoliosis. It has been postulated that human bipedalism introduces forces to the spine that increase a tendency of the vertebrae to rotate. The objective of this study was to examine the effect of body position on vertebral rotation in vivo. Thirty asymptomatic volunteers underwent magnetic resonance imaging scanning of the spine (T2-L5) in three different body positions; upright, quadrupedal-like (on hands-andknees) and supine. Vertebral rotation in the local transverse plane was measured according to a pre-established method and compared at different spinal levels between the three body positions. It was shown that in all three positions the mid-and lower thoracic vertebrae were predominantly rotated to the right. However, vertebral rotation was significantly less in the quadrupedal position than in both the standing upright and supine positions.